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Tue, Nov. 19

Treating apnea can lower your stroke chances

Dear Dr. Rosenberg:

My husband had a stroke a month ago. He snores, and when I mentioned this to his neurologist, he suggested that my husband have a sleep study to see if he has sleep apnea. My question is how would treating sleep apnea benefit him at this point?

A: If your husband has sleep apnea and is treated with CPAP (continuous positive airway pressure), possible mechanisms by which he may improve neurologically include: 1. improved oxygenation; 2. decreased frequency of blood pressure surges associated with apneas; 3. improved left ventricular function of the heart; and 4. normalized cerebral vascular reactivity and cerebral blood flow. Numerous studies have demonstrated improved recovery and a decrease in recurrence of stroke in those with sleep apnea who are treated.

Dear Dr. Rosenberg:

I've been told that sleep apnea has recently been recognized as having a serious detrimental effect on the male body's ability to produce sufficient quantities of testosterone. The way my urologist explained it to me the sleep apnea causes decreased oxygen levels in the blood. This decreased oxygen level has an adverse effect on the pituitary, which in turn malfunctions (or "under-functions") and results in lowered testosterone levels. Once the testosterone levels drop to an unhealthy level there are a whole host of maladies that can result, ranging from obesity, metabolic syndrome and diabetes to coronary artery disease. Can you verify this? Are there any published studies available which expound on the inter-relationship?

A: It is true that sleep apnea has been found to be related to low testosterone levels and erectile dysfunction. It would appear that those with the most frequent drops in oxygen, as a result of the apnea, are the most susceptible. As for the metabolic syndrome, diabetes and coronary artery disease, they can be caused by sleep apnea but not as a result of low testosterone. If you do an online search for sleep apnea and erectile dysfunction or testosterone, you will find many studies that have been written.

Dear Dr. Rosenberg:

I read your informative answers in the Daily Courier and enjoy them very much. Here is my problem. For several years I've had nightly painful legs after falling asleep. I am a side sleeper, the pain wakes me up often during the night and I then turn over to the other side until later, when the process repeats itself. It's a strong ache, with the side down being most painful, though the other one hurts, too. For a few minutes when arising in the morning, my left leg feels "prickly." A year ago, I was diagnosed with high BP and left bundle branch block. I am rather sedentary with quilting and computer stuff being my main activities. What do you think?

A: It certainly sounds like restless legs syndrome (RLS). Another possibility would be nocturnal cramping. However in that case, actual spasm of the muscle would awaken you. The fact that it is in both legs and accompanied at times by a "prickly" sensation makes RLS more likely. Additionally if it occurs predominantly after dark, that also speaks in favor of RLS. I would bring this to the attention of your primary care provider. It is a very treatable condition.

Dear Dr. Rosenberg:

Is it true that sleep apnea increases the risk of stroke? If so how?

A: Yes. A recent study from Spain showed that in a group of untreated patients with sleep apnea, the risk was two to three times normal. The causes are multiple, but the development of hypertension and the loss of the brain's ability to control its own blood flow seem to be major contributing factors in those with sleep apnea.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.

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